Presented by Michael Y. Wang, MD, FAANS, of the University of Miami.
In this episode of eOrthopodTV, Orthopaedic Surgeon Randale C. Sechrest, MD narrates this animated video describing the basics of the anatomy of the cervical spine.
See http://navigatingradiology.com for more, including suggested resources. This video introduces basic anatomy, important measurements on CT C-spine, a detailed approach, never to miss findings, commonly missed findings, fracture mimics, and example cases.
Dr. Ebraheim’s educational animated illustrates spine concepts associated the cervical spine - trauma. Transverse ligament: - It provides the C1-C2 stability - It is behind the odontoid and it anchors the odontoid to the ring of C1 so it prevents an abnormal movement between C1 and C2. - A.D.I. in adults is 3.5 mm. - Of the transverse ligament is injured, C1 and C2 will be free to move & there will be an increase in the A.D.I. - Isolated traumatic injury to the transverse ligament is probably rare. - Jefferson fracture Three types: - Type II: fracture at the base of the odontoid process, most common, troublesome fracture. - Nonunion rate is 20-80% due to interruption of the blood supply. - High nonunion rate in: - More than 5 mm of displacement. - Patients older than 50 years of age. - Other risk factors: - Delay in treatment - Posterior displacement of the fracture - Diabetes - Do not use halo in early patients, risk of death from pneumonia - Treatment of young patients: • Halo: halo traction may be needed initially to reduce fracture, halo for up to 3 months, 30% non-union rate in halo. • When do you do surgery? Displaced fracture in older patients, risk factors for no-union. • Odontoid screw is preferred in the young patient. • Need to preserve C1-C2 motion. • Do not do fusion in young patients. • Can use C1- C2 fusion in older patients. • For older patients: - Orthosis or Fusion of C1- C2 if there is an indication for surgery and if there is a clearance for surgery. Type III: - Fracture through the body of C2. - Treatment: • Cervical orthosis • Halo: if displaced • Hangman’s fracture is a bilateral fracture of the pars interarticularis • The spinal canal is wider and there will be a low risk for spinal cord injury. Levine and Edwards classification: - Type I: stable fracture with less than 3 mm displacement, no angulation, treatment: cervical orthosis. - Type II: most common type, significant translation and some angulation, unstable fracture, treatment: cervical traction and extension to improve the displacement, immobilization in halo vest for about 3 months. - Type IIa: severe angulation and slight translation seen in flexion distraction injuries with tearing of the posterior longitudinal ligament, the fracture is unstable, treatment: do not use traction when there is severe angulation of the fracture. - Type III: surgical type, C2-C3 facet dislocation, rare fracture of the pedicles in addition to the anterior facet dislocation, it has some neurological deficit association, treatment: surgery for reduction of the facet dislocation and stabilization of the injury, open reduction and posterior spine fusion. • Facet dislocations: the association of disk herniation and facet involvement is very high, so watch out for a herniated disc in addition to the bony injury. - Unilateral facet dislocation will usually have less than 50% translation on x-ray and it may affect a nerve root. - Bilateral facet dislocation will have more than 50% translation and probably a spinal cord injury. - Treatment: immediate closed reduction, get an MRI, then do surgery, if the patient has a change in mental status, then get the MRI first, and immediately followed by open reduction and surgical fixation. - When do you go anteriorly? - Go anteriorly if there is a disc herniation, incidence is about 10%-30% in cervical facet dislocation. - If you try to do reduction, the disc fragment may stay in the canal causing spinal cord injury. - When do you do posterior? - If reduction of the dislocation failed and there was no disc herniation. - When do you combined anterior and posterior procedures? - Need to go anteriorly to remove the disc - Need to go posteriorly because the dislocation cannot be reduced by a closed method or by an open anterior technique. • Important points: 1- Get the MRI before surgery: make sure there is not a disc herniation. 2- Ligament injuries do not heal: will need fusion surgery. 3- Know the arrangement of the facets: superior and inferior facets in normal, subluxed, and dislocated positions. Know the “naked facet” or the “empty facet”. Train yourself to know this, especially for exam questions. Naked Facet. Cervical Spine MRI Facet Fracture Ligamentous Injury OF THE Cervical Spine Burst Fracture of Lower Cervical Spine Tear Drop Fracture Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund: https://www.utfoundation.org/foundation/home/Give_Online.aspx?sig=29
This video “Spinal Trauma: Cervical Trauma Protocol, Common Spinal Fractures” is part of the Lecturio course “Radiology” ► WATCH the complete course on http://lectur.io/spinaltrauma ► LEARN ABOUT: - Cervical trauma protocol - Common mechanism of spine trauma - Common spinal fractures - Burst fracture - Chance fracture - Jefferson fracture - Hangman's fracture ► THE PROF: Hetal Verma has extensive experience practicing in the field of radiology. She is currently a Clinical Instructor at Harvard Medical School. Hetal has been in practice for over 10 years and has been teaching medical students and residents throughout that time. She has also been invited as a speaker at multiple teaching conferences for other physicians, technologists and the community. ► LECTURIO is your single-point resource for medical school: Study for your classes, USMLE Step 1, USMLE Step 2, MCAT or MBBS with video lectures by world-class professors, recall & USMLE-style questions and textbook articles. Create your free account now: http://lectur.io/spinaltrauma ► INSTALL our free Lecturio app iTunes Store: https://app.adjust.com/z21zrf Play Store: https://app.adjust.com/b01fak ► READ TEXTBOOK ARTICLES related to this video: http://lectur.io/spinaltraumamagazine ► SUBSCRIBE to our YouTube channel: http://lectur.io/subscribe ► WATCH MORE ON YOUTUBE: http://lectur.io/playlists ► LET’S CONNECT: • Facebook: https://www.facebook.com/lecturio.medical.education.videos • Instagram: https://www.instagram.com/lecturio_medical_videos • Twitter: https://twitter.com/LecturioMed
Presented by David O. Okonkwo, MD, PhD, FAANS, with the University of Pittsburgh Medical Center.
The P-L-I-F is defined as Posterior Lumbar Interbody Fusion This approach requires a 4-6” incision in the center of the back to access one or two levels. Initial posterior fixation is used to expand the intervertebral space. The PLIF approach removes the spinous processes with lamina, and facet joints. The spinal cord is retracted and the surgeon can access the disc. The surgeon can then remove the diseased disc nucleus to prepare the vertebral bodies for fusion. After the disc is prepared, a biocompatible polymer implant is filled with bone graft material and placed in the disc space. Procedure is repeated for the other side. Additional bone graft may be placed around the implants to increase the surface area for fusion. This procedure is normally accompanied by a posterior fixation with pedicle screws. The implant maintains the spacing of the vertebrae while the fusion takes place. After the fusion is completed and a solid bone mass forms the two vertebrae are joined together.
Cervical Spine Trauma Author: Robyn Kalke, MSK Fellow; Adnan Sheikh, MSK Radiologist; Kwan Rakhra, MSK Radiologist
Dr. Ebraheim’s educational animated video describes Hangman's fractures. Hangman's Fracture is a bilateral fracture of the pars interarticularis. The spinal canal is widened and there is a low risk for spinal cord injury. The fracture usually occurs more due to motor vehicle accidents. Anatomy •Spinous process •Body •Axis •Pars interarticularis Mechanism of injury Hyperextension will fracture the pars interarticularis with secondary flexion injury the disc and posterior ligament. The patient may have other associated spine fractures (up to 30%). Levine and Edwards classification Type I •Stable fracture with less than 3 mm displacement •No angulation •Treatment: cervical orthosis Type II •Most common type •Significant translation and some angulation •Unstable fracture •Treatment: cervical traction to improve the displacement and immobilization in halo vest. Typer IIa •Slight translation but severe angulation seen in flexion-distraction injuries with tearing of the posterior longitudinal ligament and the disc. The fracture is unstable. •Treatment: reduction in extension and compression in a Halo. Do not use traction when there is severe angulation of the fracture. Type III C2-C3 facet dislocation •Rare fracture that results from initial anterior facet dislocation of C2 on C3 followed by extension injury fracturing the neural arch. Results in translation with unilateral or bilateral facet dislocation of C2-C3 unstable fracture. •Treatment : Surgery for reduction of the facet dislocation and stabilization of the injury Typical and atypical fractures •A typical hangman’s fracture displaces the vertebral body anteriorly and its posterior element posteriorly. This creates increased space for the spinal cord. •An atypical hangman’s fracture line leaves the canal circumferentially intact, which puts the spinal cord at risk of injury if displacement occurs. Become a friend on facebook: http://www.facebook.com/drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC